Imipenem plus Fosfomycin as Salvage Therapy for Vertebral Osteomyelitis

Itaru Nakamura; Tetsuo Yamaguchi; Kotaro Aoki; Yuri Miura; Satoko Sato; Hiroaki Fujita; Hidehiro Watanabe

doi:10.1128/AAC.01746-20

Imipenem plus Fosfomycin as Salvage Therapy for Vertebral Osteomyelitis

Antimicrob Agents Chemother. 2020 Dec 16;65(1):e01746-20. doi: 10.1128/AAC.01746-20. Print 2020 Dec 16.

Authors

Itaru Nakamura¹, Tetsuo Yamaguchi², Kotaro Aoki³, Yuri Miura¹, Satoko Sato¹, Hiroaki Fujita¹, Hidehiro Watanabe¹

Affiliations

¹ Department of Infection Prevention and Control, Tokyo Medical University Hospital, Tokyo, Japan.
² Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Tokyo, Japan tetsuo.yamaguchi@med.toho-u.ac.jp.
³ Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Tokyo, Japan.

Abstract

We applied combination antibiotic therapy to treat vertebral osteomyelitis and a psoas abscess caused by glycopeptide-intermediate (MIC, 2 μg/ml) and daptomycin-nonsusceptible (>2 μg/ml) methicillin-resistant Staphylococcus aureus The Etest synergy test showed the largest synergistic effects for imipenem/cilastatin and fosfomycin. Whole-gene sequencing showed amino acid changes in SA0802, SA1193 (mprF), and SA1531 (ald). Four weeks of combination treatment using imipenem/cilastatin (1.5 g per day) and fosfomycin (4.0 g per day) resulted in clinical improvement.

Keywords: Etest synergy test; antibiotic combination; fosfomycin; imipenem; whole genome analysis.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Fosfomycin* / therapeutic use
Humans
Imipenem / therapeutic use
Methicillin-Resistant Staphylococcus aureus*
Microbial Sensitivity Tests
Osteomyelitis* / drug therapy
Salvage Therapy
Staphylococcal Infections* / drug therapy

Substances

Anti-Bacterial Agents
Fosfomycin
Imipenem